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Chemotherapy induced nausea and vomiting
- 1. Chemotherapy induced Nauseaand Vomiting Dr. V. S. Swathi Assistant Professor
- 2. Definition âą It isthe one of the most common side effect of chemotherapy drugs which is used in treatment of cancer. âą 80% of the patients with cancer will experience chemotherapy induced nausea and vomiting
- 3. Types Acute: Here patientwill experience nausea and vomiting within 24 hours of chemotherapy Delayed: Here patient will experience nausea and vomiting after 24 hours of chemotherapy Anticipated: Here patient will experience nausea and vomiting before starting of chemotherapy Break through: Even after giving prophylactic drugs to prevent chemotherapy induced nausea and vomiting, patients will have episodes of nausea and vomiting, which requires rescue antiemetics Refractory: Nausea and vomiting occurs when there is a poor response to multiple antiemetic regimens
- 4. Risk factors âą Lessthan 50 years âą Females âą History of motion sickness âą History of pregnancy related nausea and vomiting âą Alcohol use âą Emesis prior to chemotherapy âą Failure to adhere treatment guidelines âą Type of antineoplastic regimen (Drug, Dose, Route, Schedule, Combination drug)
- 5. Etiology Emetic risk Agent High(>90%) Cisplatin Cyclophosphamide â„1500mg/m2 Carmustine Dacarbazine Dactinomycin Moderate (30â90%) Oxaliplatin Cytarabine >1000mg/m2 Carboplatin Ifosfamide Cyclophosphamide Doxorubicin Daunorubicin Epirubicin Low (10â30%) Paclitaxel Docetaxel Mitoxantrone Topotecan Etoposide Pemetrexed Methotrexate Gemcitabine Cytarabine â€1000mg/m2 Fluorouracil Trastuzumab Minimal (<10%) Bevacizumab Bleomycin Busulfan Fludarabine Rituximab Vincristine
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- 10. Clinical Presentation âą Nausea âąVomiting âą Sweating âą Paleness of skin âą Palpitations
- 11. Complications âą Dehydration âą Electrolyteimbalance âą Metabolic alkalosis âą Oesophageal tear âą Under nutrition âą Weight loss âą Aspiration pneumonitis
- 12. Diagnosis âą Patient history âąClinical presentation
- 13. Non Pharmacological Treatment âąHypnosis âą Relaxation techniques âą Acupuncture âą Music therapy âą Systemic desensitization âą Guided imagery âą Biofeedback
- 14. Treatment options forChemotherapy induced Nausea and Vomiting For high risk of Emesis Acute CINV Delayed CINV DAY 1 DAY 2 DAY 3 DAY 4 Aprepitant 125mg-PO-1 Aprepitant 80mg-PO-1 Aprepitant 80mg-PO-1 - Dolasetron 100mg-PO-1/ Granisetron 2mg-PO-1 - - - Dexamethasone 12mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1
- 15. Treatment options forChemotherapy induced Nausea and Vomiting For high risk of Emesis Acute CINV Delayed CINV DAY 1 DAY 2 DAY 3 DAY 4 Fosaprepitant 150mg-IV-1 - - - Dolasetron 100mg-PO-1/ Granisetron 2mg-PO-1 - - - - Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1
- 16. Treatment options forChemotherapy induced Nausea and Vomiting For high risk of Emesis Acute CINV Delayed CINV DAY 1 DAY 2 DAY 3 DAY 4 Rolapitant 180mg-PO-1 - - - Ondansetron 16-24mg-PO-1 - - - Dexamethasone 20mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1
- 17. Treatment options forChemotherapy induced Nausea and Vomiting Acute CINV Delayed CINV DAY 1 DAY 2 DAY 3 DAY 4 Netupitant 300mg-PO-1 - - - Palasetron 0.5mg-PO-1 - - - Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1 Dexamethasone 8mg-PO/IV-1 For high risk of Emesis
- 18. Treatment options forChemotherapy induced Nausea and Vomiting Acute CINV Delayed CINV DAY 1 DAY 2 DAY 3 Netupitant 300mg-PO-1 - - Palasetron 0.5mg-PO-1 Dolasetron-100mg-PO/ Granisetron 1-2mg-PO/ Ondansetron-16mg-PO Dolasetron-100mg-PO/ Granisetron 1-2mg-PO/ Ondansetron-16mg-PO Dexamethasone 8mg-PO/IV-1 - - For moderate risk of Emesis
- 19. Treatment options forChemotherapy induced Nausea and Vomiting Acute CINV DAY 1 Dexamethasone 12mg-IV/PO-1/ Dolasetron-100mg-PO-1/ Granisetron-1-2mg-PO-1/ Ondansetron-8-16mg-PO-1 For low risk of Emesis
- 20. Treatment options forChemotherapy induced Nausea and Vomiting For minimal risk of Emesis- No treatment required Anticipatory CINV âą Non pharmacological treatment âą Alprazolam or Lorazepam Refractory CINV âą Use different combinations of anti emetics âą Add rescue anti emetics
- 21. Treatment options forChemotherapy induced Nausea and Vomiting Breakthrough CINV Adults â Prochlorperazine â Promethazine â Lorazepam â Metaclopromide â Haloperidol â Dexamethasone One dose in the evening of day before chemotherapy Next dose 1-2 hours prior to chemotherapy Children â Chlorpromazine â Lorazepam â Dexamethasone
- 22. Drugs used intreatment of Chemotherapy induced Nausea and Vomiting (CINV) Drug Category Mode of action Adverse effects Aprepitant NK 1 receptor antagonist Antagonises the actions of substance P/ Neurokinin 1 receptors ï· Head ache ï· Asthenia ï· Anorexia ï· GI disturbances ï· Alopecia Fosaprepitant NK 1 receptor antagonist Antagonises the actions of substance P/ Neurokinin 1 receptors ï· Head ache ï· Asthenia ï· Anorexia ï· GI disturbances ï· Alopecia Rotapitant NK 1 receptor antagonist Antagonises the actions of substance P/ Neurokinin 1 receptors ï· Neutropenia ï· Loss of appetite ï· Dizziness ï· Dyspepsia ï· Urinary tract infection
- 23. Drugs used intreatment of Chemotherapy induced Nausea and Vomiting (CINV) Netupitant NK 1 receptor antagonist Antagonises the actions of substance P/ Neurokinin 1 receptors ï· Head ache ï· Asthenia ï· Dyspepsia ï· Hepatotoxicity ï· Erythema Palanosetron 5 HT3 receptor antagonist Antagonises the actions of serotonin ï· QT prolongation ï· Anxiety ï· GI disturbances ï· Hyperkaelemia ï· Hepatotoxicity Granisetron 5 HT3 receptor antagonist Antagonises the actions of serotonin ï· Head ache ï· GI disturbances ï· Asthenia ï· Somnolenance ï· Sedation
- 24. Drugs used intreatment of Chemotherapy induced Nausea and Vomiting (CINV) Ondansetron 5 HT3 receptor antagonist Antagonises the actions of serotonin ï· Head ache ï· Malaise ï· Hypoxia ï· Anxiety ï· Urinary retention Dolasetron 5 HT3 receptor antagonist Antagonises the actions of serotonin ï· Head ache ï· Diarrhea ï· Hypertension ï· Arrhythmia ï· GI disturbances Alprazolam Benzodiazepine Decreased anxiety related to chemotherapy ï· Drowsiness ï· Depression ï· Head ache ï· GI disturbances ï· Dry mouth Lorazepam Benzodiazepine Decreased anxiety related to chemotherapy ï· Sedation ï· Amnesia ï· Vertigo ï· Asthenia ï· Tremor
- 25. Resources âą https://www.ncbi.nlm.nih.gov/pmc/articles/PMC39 38333/pdf/nihms454621.pdf âą http://www.ijmpo.org/article.asp?issn=0971- 5851;year=2017;volume=38;issue=3;spage=334; epage=339;aulast=Baburaj âąhttps://www.frontiersin.org/articles/10.3389/fphar. 2017.00019/full âą https://www.ons.org/sites/default/files/hawkins.pdf âą https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31 88425/pdf/nihms-261834.pdf